Health Brief: Humana Will Not Offer 2018 Exchange Plans

Washington Brief

  • Congressional Republicans haven’t reached a consensus on basic issues for their Obamacare repeal plan, including how much of the law to repeal, what to replace it with and when. (Politico)
  • One of the divisions centers around Medicaid reform for the reconciliation bill. In the House, GOP lawmakers are weighing whether to shift funding for the program to per capita allotments or allow states to choose block grants. (Morning Consult)
  • Secretary of Health and Human Services Tom Price is set to meet with Senate Republicans today. They’ll discuss what steps Price can take in his new role to repeal and replace the ACA, Sen. John Barrasso (R-Wyo.) told reporters.

Business Brief

  • Humana became the first major insurer to announce it plans to no longer offer health plans on state markets established under Obamacare in 2018. (The New York Times)
  • The mergers between Cigna and Anthem and Aetna and Humana are collapsing following court rulings that found they violated federal antitrust law. Cigna is seeking more than $13 billion in damages from Anthem in addition to a $1.85 billion breakup fee. (The Wall Street Journal)
  • More than 39 percent of Americans under 65 are enrolled in a plan with a high deductible, an uptick from 2010, when the percentage was 25 percent, according to the latest data from the National Health Interview Survey. (Axios)

Chart Review

Events Calendar (All Times Local)

KPMG event on the health IT agenda 8:30 a.m.
Senate Appropriations Committee hearing on mental health care treatment and services 10:30 a.m.
Families USA Health Action 2017 8:30 a.m.
House Judiciary subcommittee hearing on competitive health insurance Reform Act of 2017 10 a.m.
CAHC event on ACA replacement and subsidy portability 10 a.m.
Senate Finance Committee confirmation hearing on Seema Verma’s nomination to lead CMS 10 a.m.
Families USA Health Action 2017 7:30 a.m.



Doubts grow that GOP can repeal Obamacare
Burgess Everett et al., Politico

Republicans have reached a gut check moment: After spending more than six years vowing to fix the flagging patient that is Obamacare, it’s the GOP’s own repeal effort that’s on life support. Undoing the health care law despised by conservatives seemed to be a straightforward proposition for the party after it won the White House and retained control of both chambers of Congress.

Will Obamacare Really Go Under the Knife?
Robert Draper, The New York Times

Six days after he was sworn in as America’s 45th president, Donald J. Trump traveled to Philadelphia to address Republican lawmakers at their annual retreat. Standing behind a lectern emblazoned with the presidential seal, Trump predicted, “This Congress is going to be the busiest Congress we’ve had in decades.”

Door Opens to Gene Editing in Embryos
Amy Dockser Marcus, The Wall Street Journal

Clinical trials involving the editing of genes in sperm, eggs and early-stage embryos could be permitted under certain conditions, the National Academies of Sciences and the National Academy of Medicine recommended Tuesday in a long-awaited report. Once technical questions are resolved, clinical trials could start with extensive oversight, the report said.

Bipartisan bill aims to crack down on illicit opioid shipments into US
Dylan Scott, Stat News

Aiming to choke off shipments of powerful synthetic opioids such as fentanyl, a bipartisan group of lawmakers is introducing legislation on Tuesday to require more information on packages mailed into the US. The bill, sponsored in the Senate by Republicans Rob Portman and Marco Rubio along with Democrats Amy Klobuchar and Maggie Hassan, was introduced late last Congress but never moved.

Yellen Fuels Bank Stocks as Traders Eye Inflation: Markets Wrap
Eddie van der Walt and Adam Haigh, Bloomberg News

Banks led gains in global stocks as traders awaited U.S. inflation data that looks poised to further strengthen the Federal Reserve’s resolve to raise interest rates. Treasuries fell for a fifth day and the dollar extended its advance.


Humana Plans to Pull Out of Obamacare’s Insurance Exchanges
Reed Abelson, The New York Times

Humana announced on Tuesday that it would no longer offer health insurance coverage in the state marketplaces created under the federal health care law, becoming the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018. President Trump immediately seized on the company’s decision as evidence that the Affordable Care Act needed to be repealed and replaced.

Antitrust Rulings Put Chill on Health-Insurance Mergers
Anna Wilde Matthews and Brent Kendall, The Wall Street Journal

Two health-insurance mergers worth a combined $82 billion are unraveling in the wake of court rulings that found the transactions violated federal antitrust law, all but quashing a deal boom that would have reshaped the industry. Aetna Inc. and Humana Inc. said Tuesday they would terminate their $34 billion merger agreement instead of attempting to appeal a judge’s decision last month that their combination would harm senior citizens.

GOP Considers Medicaid Reforms for Reconciliation Bill
Mary Ellen McIntire, Morning Consult 

House Republicans are weighing specific reforms to Medicaid that could be included in a reconciliation measure to overhaul the Affordable Care Act. How to deal with the federal expansion of Medicaid under the ACA is one of the main unanswered questions as Congress works to overhaul Obamacare — one that has exposed divisions between the House’s most conservative members and GOP lawmakers from states that chose to expand the federal program for low-income Americans.

Uninsured rate is down, but deductibles are up
Bob Herman, Axios

Just 8.8% of Americans lacked health insurance as of this past September, according to the latest numbers from the National Health Interview Survey conducted by the Centers for Disease Control and Prevention. That historic low is due in large part to the Affordable Care Act’s expansion of coverage through the exchanges and Medicaid.

Major Blow to Obamacare Mandate: IRS Won’t Reject Tax Returns That Don’t Answer Health Insurance Question
Peter Suderman, Reason

How much difference does a single line on a tax form make? For Obamacare’s individual mandate, the answer might be quite a lot.

Aetna plan to divest Louisiana Medicare Advantage business scuttled by called-off $34 billion Humana merger
The Advocate 

Major health insurers Aetna and Humana called off their $34 billion combination after a federal judge, citing concerns about prices and benefits, rejected the deal. Aetna had planned to sell its Louisiana Medicare Advantage business to Molina Healthcare Inc. as part of the now-defunct merger with Humana.

State Would Protect Planned Parenthood Medicaid Funds Under Malloy Proposal
Arielle Levin Becker, The Hartford Courant

As Republicans in Congress seek to cut off federal funds to Planned Parenthood, Gov. Dannel P. Malloy has proposed legislation that would allow the state to make up any federal Medicaid dollars the clinics would lose. Malloy did not include any additional money to go with the proposal in the budget he introduced last week – something a spokesman for his budget office said reflected the uncertainties about what changes might occur at the federal level.

Georgia governor signs hospital provider fee to fill Medicaid gap
Greg Bluestein, The Atlanta Journal-Constitution 

Georgia’s Medicaid program received a shot in the arm Monday when Gov. Nathan Deal signed a measure into law that will avert a roughly $900 million gap in Medicaid funding. The governor signed Senate Bill 70 into law after both chambers swiftly approved the measure, which allows the Department of Community Health board to levy a hospital provider fee for an additional three years.

Major hospitals pull out of Alabama Medicaid reform, call for delay
Amy Yurkanin,

An overhaul of the state’s Medicaid program that has already been postponed a year could face more delays after the departure of several health care systems over concerns about the program’s direction and costs. State leaders have been working since 2012 to transform the Medicaid program from a system that pays for unlimited services to managed care that caps costs at a certain amount per patient to control spending.


SSM names Intermountain exec Laura Kaiser as new CEO
Rachel Arndt, Modern Healthcare

The SSM Health board of directors named Laura Kaiser the new president and CEO of the St. Louis-based Catholic health system. On May 1, Kaiser will take over the position, which was previously held by William Thompson, who announced his retirement in June 2016.

Catholic hospital denies unfair bias against transgender man
The Associated Press

A Catholic hospital denies that it unfairly discriminated against a transgender man who sued after the hospital refused to allow a surgeon to remove the man’s uterus as part of his sex transition. Saint Joseph’s Healthcare System said that a court ruling in Jionni Conforti’s favor would violate its constitutional right to freedom of religion.

Pharma, Biotech and Devices

Merck Stops Alzheimer’s Study After ‘No Chance’ of Benefit
Michelle Cortez, Bloomberg News

Merck & Co. will end a study of its once-promising Alzheimer’s disease drug in patients with mild-to-moderate forms of the condition, just three months after Eli Lilly & Co. announced its own setback in a field that’s been littered with failures. There was “virtually no chance of finding a positive clinical effect,” according to an independent panel of experts that looked at the trial partway through.

CEO Under Fire for $89,000 Drug Has a History of Steep Price Hikes
Katherine Greifeld and Robert Langreth, Bloomberg News

The CEO of the latest drugmaker to face criticism over a product’s high price has a history of steep hikes on other drugs and at past companies. Marathon Pharmaceuticals LLC Chief Executive Officer Jeffrey Aronin, under fire for setting an $89,000 price on the company’s drug for a rare, deadly muscle disease, was questioned in a letter more than two years ago by Washington lawmakers about mark-ups on two heart drugs.

Health IT

Apprio to Offer Agencies Health IT Services Under GSA Schedule 70
Ramona Adams, ExecutiveBiz

Apprio will offer health information technology services to federal customers through the General Services Administration‘s IT Schedule 70 contract vehicle. The company said Monday its service offerings under the contract’s health IT special item number will cover electronic health records, software engineering, program management, claims administrations, big data and interoperability.

A Message from the Coalition for Affordable Prescription Drugs:

Federal programs, state governments, employers, unions and others partner with PBMs to address rising prescription drug costs, keep patients healthy and deliver value for the health system. Visit for more.

Opinions, Editorials and Perspectives

State Flexibility and Universal Coverage
Ipsita Smolinski, Morning Consult 

With the health care industry in a state of limbo amid news of ACA repeal, repair and replace, one idea that has received far less attention than others is the concept of state flexibility. Republicans have used this notion to both bolster a state’s rights argument, as well as point to a means for expanded health care coverage driven on a state level.

The ObamaCare Merger Deathblow
The Editorial Board, The Wall Street Journal

The conceit that the five major commercial health insurers will consolidate to three seems to be dissolving, as four of those insurers called off a pair of mega-mergers on Tuesday. The immediate reasons were legal objections, but perhaps this retreat is a sign of hope for insurance markets.

We created Medicare for the elderly. Why not do the same for children?
Kurt Newman, The Washington Post 

With all eyes focused on the nation’s health-care system, our leaders have an opportunity to put the health and future of America’s children first. Congress should consider building a tailor-made national health-care plan just for children.

A Message from the Coalition for Affordable Prescription Drugs:

Federal programs, state governments, employers, unions and others partner with PBMs to address rising prescription drug costs, keep patients healthy and deliver value for the health system. Visit for more.

Research Reports

Insurance Coverage Changes for People with HIV Under the ACA
Jennifer Kates and Lindsey Dawson, The Kaiser Family Foundation

Prior to the Affordable Care Act (ACA), people with HIV faced limited access to insurance coverage due to several barriers, including pre-existing condition exclusions, high costs, Medicaid eligibility limitations, and other challenges. Several key provisions of the ACA removed these barriers.